Comparison of dispensed medications and forensic‐toxicological findings to assess pharmacotherapy in the Swedish population 2006 to 2013

Forsman, Jonas; Taipale, Heidi; Masterman, Thomas; Tiihonen, Jari; Tanskanen, Antti

doi:10.1002/pds.4426

Cited by 25 publications

(23 citation statements)

References 32 publications

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“…In addition to these, PRE2DUP considers changes of doses, possible inpatient care (wherein drug use is not recorded on the registers) and stockpiling of drugs. PRE2DUP and the validity of this method are described in detail in previous studies [16][17][18].…”

Section: Exposurementioning

confidence: 99%

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

Puranen

Koponen

Tanskanen

et al. 2020

Eur J Clin Pharmacol

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Purpose Antipsychotics are first-line treatment of schizophrenia. They are often accompanied by adjunctive treatments, such as antidepressant (AD) or mood stabilizer (MS), although there is only limited information of their use in first-episode schizophrenia. This study aimed to investigate AD and MS initiation and factors associated with initiation in persons with first-episode schizophrenia. Methods Register-based data was utilized to identify persons who received inpatient care due to schizophrenia during 1996-2014 in Finland and who did not use AD or MS at the time of first inpatient care diagnosis of schizophrenia (N = 7667, mean age 40.2, SD 18.2). Drug purchase data (1995-2017) was obtained from the National Prescription register and modelled with PRE2DUP method. Initiations of AD and MS use were followed up 3 years from first schizophrenia diagnoses. Cox proportional hazard models were used to investigate factors associated with AD or MS initiation. Results Among persons with first-episode schizophrenia, 35.4% initiated AD and 14.1% initiated MS use within three years from diagnoses. Female gender, younger age, and benzodiazepine use were associated with higher risk of AD and MS initiation. The number of previous psychoses was associated with decreased risk of AD and increased risk of MS initiation. Conclusion Clinical guidelines rarely recommend the use of AD or MS as adjunctive treatment in persons with schizophrenia. However, this population is often treated with AD or MS. More studies are needed to evaluate benefits and risks of these medications as adjunctive treatment of schizophrenia.

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Section: Exposurementioning

confidence: 99%

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

Puranen

Koponen

Tanskanen

et al. 2020

Eur J Clin Pharmacol

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“…As with any drug that is recommended on a daily basis, adherence needs to be assessed in individuals on clozapine. Treatment non‐adherence may be lower with clozapine than with other antipsychotics , but data from a 15‐year cohort of 320 cases show that 57% of clozapine‐treated patients had at least one treatment interruption over this period of time with being drug non‐adherent the most common cause for treatment interruption . Ongoing psychoeducation needs to be delivered about the risks of treatment non‐adherence, which include cholinergic rebound, seizures upon re‐introduction of full dose without titration, and relapse of psychosis.…”

Section: From Research To Clinical Practice: When and How To Prescribmentioning

confidence: 99%

How and when to use clozapine

Rubio

Kane

2019

Acta Psychiatr Scand

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Objective Clozapine is the only approved strategy for treatment‐resistant schizophrenia, although it is highly underutilized. We aim to generate practical and actionable evidence‐based recommendations for the use of this drug considering prescription barriers. Method Narrative review. Results A consistent body of evidence supports the efficacy of clozapine reducing morbidity and mortality in schizophrenia. The main obstacles to its use are the lack of experience by prescribers and perceived treatment burden. Systematic screening of eligibility, utilization of available resources for consultation, developing a professional network with other stakeholders, as well as optimizing how clozapine is presented to patients is discussed. Furthermore, specific evidence‐based recommendations for initiation, maintenance, and safety monitoring with clozapine are provided. Conclusion Clozapine prescription is one of the areas in psychiatry with the greatest mismatch between efficacy and utilization in clinical practice. Although multiple barriers to the use of clozapine exist, some of these may be overcome by updates of routine clinical practice.

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“…Expected medication-use periods were modeled using the Prescription Registry by PRE2DUP, as previously described [26,28]. The method is based on sliding averages of daily defined doses (DDD) calculated for each medication over time, taking personal medication-purchasing behavior and medication stockpiling into account; in the case of single purchases, the expected duration of the purchased package was used [38].…”

Section: Pre2dupmentioning

confidence: 99%

“…Apart from published reports using Swedish registry data to assess adherence to non-addictive medications in the general population [28]; to psychotropic medications in homicide offenders and victims [29]; and to antidepressants among young suicide victims [30], no previous study has exploited discrepancies between person-level prescription and toxicology data derived from nationwide registries to investigate biochemically verified pharmacoadherence.…”

Section: Introductionmentioning

confidence: 99%

Adherence to psychotropic medication in completed suicide in Sweden 2006–2013: a forensic-toxicological matched case-control study

Forsman

Taipale

Masterman

et al. 2019

Eur J Clin Pharmacol

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Objective To investigate the influence of adherence to psychotropic medications upon the risk of completed suicide by comparing person-level prescriptions and postmortem toxicological findings among complete-suicide cases and non-suicide controls in Sweden 2006-2013. Methods Using national registries with full coverage on dispensed prescriptions, results of medico-legal autopsies, causes of death, and diagnoses from inpatient care, estimated continuous drug use for 30 commonly prescribed psychotropic medications was compared with forensic-toxicological findings. Subjects who had died by suicide (cases) were matched (1:2) with subjects who had died of other causes (controls) for age, sex, and year of death. Odds ratios were calculated using logistic regression to estimate the risk of completed suicide conferred by partial adherence and non-adherence to pharmacotherapy. Adjustments were made for previous inpatient care and the ratio of initiated and discontinued dispensed prescriptions, a measure of the continued need of treatment preceding death. Results In 5294 suicide cases and 9879 non-suicide controls, after adjusting for the dispensation ratio and other covariates, partial adherence and non-adherence to antipsychotics were associated with 6.7-fold and 12.4-fold risks of completed suicide, respectively, whereas corresponding risk estimates for antidepressant treatment were not statistically significant and corresponding risk increases for incomplete adherence to antidepressant treatment were lower (1.6-fold and 1.5-fold, respectively) and lacked statistical significance. Conclusion After adjustment for the need of treatment, biochemically verified incomplete adherence to antipsychotic pharmacotherapy was associated with markedly increased risks of completed suicide.

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Comparison of dispensed medications and forensic‐toxicological findings to assess pharmacotherapy in the Swedish population 2006 to 2013

Cited by 25 publications

References 32 publications

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

How and when to use clozapine

Adherence to psychotropic medication in completed suicide in Sweden 2006–2013: a forensic-toxicological matched case-control study

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